Paediatrics

Question 1

Sore throat

Answer 1

No routine swab/antigen test

Centor criteria:(1 point each)
Cervical lymph node
Tonsillar exudate
Fever
No cough

> 3: antibiotics- phenoxymethylpenicillin for 7-10 days, if allergy then clarithromycin

Who definitely need antibiotics:

1. Systemically unwell
2. Unilateral peri tonsillitis
3. Hx of rheumatic fever
4. Diabetes/immunodeficiency
5. 3 or more on centor criteria

Question 2

Child abuse types

Answer 2

Emotional
Physical(such as Münchhausen by proxy)
Sexual
Neglect

Question 3

UTI in children further investigations

Answer 3

USS
If atypical — USS tract during acute episode regardless of age
If recurrent—— > 6 months old then USS in 6 weeks
< 6 months old then USS also during acute episode

Also USS in 6 weeks If less than 6 months old and first time UTI

DMSA(always 4-6 months after acute attack to see damage)
<3 years old then needed for atypical and recurrent
>3 years old then only for recurrent

Question 4

Pinworm infection

Answer 4

Kids with itchy bottom/back
Dx: transparent tape on bottom which catches the worm
Tx: mebendazole for the whole family

Question 5

Scarlet fever

Answer 5

Kids with sore throat, fever and malaise, NOTIFIABLE DISEASE!
Also
-widespread rash with mouth sparing (pinhead erythema on trunk then limbs, sandpaper texture)
-strawberry tongue
-desquamation of hands and feet after rash

Tx: PO penicillin V for 10 days or azithromycin with pen allergy
Kids can go back to school after abx started

Complications:
Otitis media (most common)
Rheumatic fever
Acute post-strep glomerulonephritis

Question 6

CROUP

Answer 6

Parainfluenza virus

Swelling of upper airways

“Stridor” condition: Inspiratory high- pitched noise
Barking cough, hoarseness

Clinical diagnosis
Neck X-ray: “steeple” sign, like the sharp top of a church

Tx: may need admission if systemically v unwell
Dexamethasone everyone!

Question 7

Cows’ milk protein allergy

Answer 7

Kid with diarrhoea and eczema after introducing bottle milk, failure to thrive

Tx: stop and gradually introduce with the milk ladder

Question 8

Milestones- gross motor

Answer 8

Just remember to travel from head to toe the 1st year of life in increments of 3 months.

3 Months = Head - Holds head in upright position

6 Months = Trunk - Sits unsupported

9 Months = Knees - Crawling

12 Months = Feet - Walking

Then the 2nd year of life, remember to double it and go by increments of 6 months.

18 Months = Run - “Run” away from home at 18 years old

24 Months = Jump - Both (2) feet leave ground

Lastly, remember to double the increments again and go by 12 months for the next 2 years of life.

3 Years = Tricycle - “Tri” = 3

4 Years = Hop on 1 Foot - Tree yoga pose shaped like 4

Question 9

Benign Rolandic epilepsy

Answer 9

2-12 years old kids, in the middle of night, brief and simple partial seizure(so no loss of consciousness) which usually involves half of the face

Normally no treatment needed

Question 10

Epilepsy maintenance medications (1st and 2nd line)

Answer 10

General Tonic- Clonic:

1. Sodium valprorate
2. Lamotrigine

Atonic
Same as GTC

Absence
Same as GTC apart from you can also give ethosuximide as 1st line

So the two “A” epilepsy is the same as GTC

Partial (cause it is partial, so opposite of GTC, so 1st and 2nd line reversed):

1. Carbamezepine/Lamotrigine
2. Sodium valprorate

Myoclonic (1st line is the same as GTC)

1. Sodium valprorate
2. Levetiracetam/ Topiramate